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NPI Code Detail

MEDICARE: MARVIN MCKENZIE PHARMD

MEDICARE:   MARVIN  MCKENZIE  PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist12149TN

General Provider Information

NPI Number : 1639481609
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARVIN MCKENZIE PHARMD
Provider Business Mailing Address
First Line : 1332 NORTH HIGHLAND AVENUE
Second Line :
City : JACKSON
State : TN
Zip : 38301-4019
Country : US
Telephone Number : 731-427-4992
Fax Number : 731-427-2456
Provider Business Practice Location Address
First Line : 1332 NORTH HIGHLAND AVENUE
Second Line :
City : JACKSON
State : TN
Zip : 38301-4019
Country : US
Telephone Number : 731-427-4992
Fax Number : 731-427-2456
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2010
Last Update Date : 07/07/2010

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Directions to “ MARVIN MCKENZIE PHARMD” Practice Location

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